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Relation between reperfusion and hemorrhagic transformation in acute ischemic stroke
Alexander D Horsch1,2, Jan Willem Dankbaar3, Yolanda van der Graaf4
1Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132, 3584 CX, Utrecht, The Netherlands. alexanderhorsch@gmail.com.
Neuroradiology
|September 5, 2015
Summary
Hemorrhagic transformation (HT) risk after acute ischemic stroke treatment is not linked to reperfusion status. This finding applies to patients receiving intravenous recombinant tissue plasminogen activator (IV-rtPA) and those who do not.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Medicine
Background:
- Intravenous recombinant tissue plasminogen activator (IV-rtPA) is a standard treatment for acute ischemic stroke, aiming to restore blood flow.
- Hemorrhagic transformation (HT) is a significant complication following IV-rtPA, potentially linked to blood-brain barrier (BBB) injury.
- The precise relationship between reperfusion and HT, and whether IV-rtPA directly impacts BBB integrity, remains unclear.
Purpose of the Study:
- To investigate the association between reperfusion and the occurrence of hemorrhagic transformation (HT) in acute ischemic stroke patients.
- To determine if reperfusion status influences HT risk, independent of IV-rtPA treatment.
Main Methods:
- Retrospective analysis of 299 patients from the DUST study with CT perfusion (CTP) and non-contrast CT (NCCT) imaging.
- Reperfusion was assessed qualitatively using CTP, and HT occurrence was evaluated on follow-up NCCT.
- Statistical analysis included calculating odds ratios (ORs) and 95% confidence intervals (CIs), with stratification for IV-rtPA treatment.
Main Results:
- No significant association was found between reperfusion and HT overall (OR 1.2, 95% CI 0.5-3.1).
- In patients treated with IV-rtPA, the OR for HT associated with reperfusion was 1.3 (95% CI 0.4-4.0).
- In patients not treated with IV-rtPA, the OR for HT associated with reperfusion was 0.8 (95% CI 0.1-4.5). HT occurred in 14% of IV-rtPA patients versus 7% of non-IV-rtPA patients.
Conclusions:
- The risk of hemorrhagic transformation (HT) after acute ischemic stroke treatment does not appear to be dependent on reperfusion status.
- These findings suggest that factors other than reperfusion may drive HT risk in stroke patients, warranting further investigation into BBB integrity and IV-rtPA effects.
